Download Learn More About Hysteroscopies

A Guide to Hysteroscopy
Patient Education
QUESTIONS AND ANSWERS ABOUT HYSTEROSCOPY
Your doctor has recommended that you have a procedure
called a hysteroscopy. Naturally, you may have questions
about how and why the procedure is done, what to expect,
and how much risk and discomfort it may involve. This
brochure will help to answer many of the questions and
concerns you might have about hysteroscopy.
G L O S S A RY
Benign: Noncancerous.
Cervix: The portion of the uterus that extends out into the
cavity of the vagina.
Dilation and curettage (D&C): Temporary widening of the
cervix and scraping of the endothelium (inner lining of the uterus)
in order to diagnose diseases, treat abnormal vaginal bleeding,
or remove the products of contraception.
Endometrium: The lining of the uterus.
Fallopian tubes: The tubes through which the ovum (egg) is
carried to the uterus.
Fibroid (myoma): A benign tumor of the uterus.
Foley catheter: A hollow, flexible rubber tube usually used to
drain the bladder after surgery.
Hysterectomy: Surgical removal of the uterus.
Hysteroscope: A thin, telescopic instrument that allows doctors to
examine the uterus and fallopian tubes and perform some types
of surgery.
Infertility: The inability to conceive.
Intrauterine adhesion: A band of scar tissue within the lining of
the uterus.
Intrauterine device (IUD): A reversible contraception device that
is inserted into the uterine cavity.
Polyp: A benign growth that projects from a mucous
membrane surface, such as the lining of the uterus.
Uterine septum: A condition, present at birth, in which there is
an extra fold of tissue down the center of the uterus, which may
cause infertility.
Uterus: The woman’s internal reproductive organ, sometimes
referred to as the “womb.”
2
Questions and Answers About Hysteroscopy
What is a hysteroscopy?
Hysteroscopy is a technique that allows a doctor to look directly into
your cervical canal and uterus. It is typically done during the first
week or so after your period. A thin, telescopic instrument called
a hysteroscope is inserted into the uterus through the cervix,
allowing the doctor to examine the interior shape and lining of your
uterus and fallopian tubes. The purpose is to look for any evidence
of abnormalities or disease and to decide which approach to take
for treatment.
Fallopian Tubes
Uterus
Ovary
Cervix
Why perform a hysteroscopy?
The most common reason for performing a hysteroscopy is to
determine the cause of heavy or abnormal vaginal bleeding. Your
doctor can also look for the underlying causes of infertility (the
inability to conceive a child) or repeated miscarriages.
Hysteroscopy can uncover and sometimes immediately treat many
types of irregularities, most of which are benign (noncancerous) in
nature, including:
Questions and Answers About Hysteroscopy
3
Submucous Myoma
Polyp
• Fibroids (myomas)—firm, benign growths
of the uterus that can be found in an
estimated 30 percent of women over the
age of 35. Women with large fibroids
are at greater risk for abnormal uterine
bleeding and miscarriages. Fibroids can
also cause pain and abdominal pressure.
• Polyps—soft growths that project from
mucous membrane surfaces, such as the
lining of the cervix and the endometrium
(the lining of the uterus). They are usually
benign and may cause abnormal uterine
bleeding.
• Uterine septum—an extra fold of tissue
down the center of the uterus, present
from birth and associated with infertility and
miscarriages.
Septum
• Intrauterine adhesions—bands of scar
tissue between the walls of the uterus.
They may cause amenorrhea (the absence
of normal menstrual periods) and infertility.
• Blocking of the fallopian tubes—a condition
that may cause infertility. Repairing these
obstructions may increase your chances of
becoming pregnant.
What are the benefits of hysteroscopy?
Hysteroscopies can be performed quickly and conveniently in
the doctor’s office, surgical center, or hospital. Diagnostic
hysteroscopy only takes a few minutes, and you can go home
shortly after the procedure. Even when an operative procedure is
performed, the recovery time is very short. Almost all patients go
home the same day after hysteroscopic surgery. Unlike some other
procedures, there is very little pain after hysteroscopic surgery and
problems such as injury to the cervix or the uterus, infection, or
heavy bleeding occur in less than one percent of patients.
4
Questions and Answers About Hysteroscopy
What types of hysteroscopy are there?
Hysteroscopy can be either diagnostic (finding the cause of
a disorder) or operative (surgically treating the cause of the
disorder). Operative hysteroscopy can also be used for permanent
sterilization by placing a small device into the tube at the junction
with the uterus.
What is diagnostic hysteroscopy?
In diagnostic hysteroscopy, a hysteroscope is used to look for
growths and other abnormalities in the uterus. It can be done in the
doctor’s office in only a few minutes. It may be used instead of—
or in addition to—dilation and curettage (D&C), a procedure
in which the lining of the uterus is scraped and a tissue
sample can be taken and analyzed. Diagnostic hysteroscopy is
used to evaluate the cause of infertility, repeated miscarriages, or
abnormal bleeding.
How is diagnostic hysteroscopy done?
To prepare for diagnostic hysteroscopy, the doctor may first use an
antiseptic in the vagina and then numb your cervix to prevent discomfort during dilation, which is done to extend the cervix to better see during the procedure. Your vagina and cervix are then
washed with an antiseptic solution. A tiny video camera and
light are attached to the hysteroscope to allow the doctor to see
inside the uterus. The hysteroscope is inserted through the opening of the cervix and into the uterus. Meanwhile, fluid or carbon
dioxide gas is pumped into the uterus to keep it inflated and allow
the doctor to see more easily. The doctor looks for fibroids,
polyps, or other problems that may be causing bleeding. A small
plastic tube may also be used to take tissue samples from the lining of the uterus. Normally, the procedure takes several minutes.
What is operative hysteroscopy?
Operative hysteroscopy is used to treat many of the irregularities or
disorders that may be uncovered during diagnostic hysteroscopy.
It can be used to remove polyps, fibroids situated within the
uterine cavity, or intrauterine devices (IUDs) that have become
embedded in the wall of the uterus. Hysteroscopy can also be
Questions and Answers About Hysteroscopy
5
used to repair certain structural abnormalities you may have had
since birth, such as a uterine septum. It can also be used to perform
endometrial ablation, also known as uterine resection (removal of
the lining of the uterus), to treat abnormal bleeding. In some cases,
endometrial ablation is an alternative to hysterectomy (removal of
the uterus), with a shorter recovery time and better patient
satisfaction. Hysteroscopy can be used to relieve tubal blockage
at the junction with the uterus, to promote fertility, or to close the
tube for permanent sterilization.
How is operative hysteroscopy done?
Operative hysteroscopy can often be performed during the same
visit as a diagnostic hysteroscopy, or it can be done at a later time.
It is much like diagnostic hysteroscopy except that a slightly wider
instrument might be used to allow surgical instruments, such as
scissors, biopsy forceps, electrosurgical or laser instruments, and
graspers to be inserted into the uterus. Depending on which procedures are performed, it may take anywhere from several
minutes to over an hour. Ask your doctor how long the procedure
will take.
Operative hysteroscopy can be performed under general, regional,
or local anesthesia, depending on the doctor’s preference and the
type of procedure expected. As in diagnostic hysteroscopy, the
doctor will dilate your cervix, insert the hysteroscope into the uterine
cavity, and fill the uterus with gas or fluid to get a better view. The
instruments are used to remove fibroids, scar tissue, and polyps,
and to repair structural abnormalities such as a uterine septum.
Operative hysteroscopy can also be used to perform endometrial
ablation (removal of the uterine lining to treat heavy bleeding). In
this case, the doctor may refer to the procedure as a “resection.”
Operative hysteroscopy may also be used to open blocked tubes
or insert a small device to close off the tubes for sterilization.
Following your surgery, a Foley catheter or IUD may be placed
inside the uterus to prevent the uterine walls from sticking together and forming scar tissue. The doctor may prescribe antibiotics
and/or hormone medications after uterine surgery to prevent infection and to speed up healing.
6
Questions and Answers About Hysteroscopy
What happens after the procedure?
If local anesthesia is used, you may be able to go home shortly
after the procedure. If regional or general anesthesia is used, you
may need to be watched for several hours before going home.
After operative hysteroscopy, you may have mild cramping, which
usually is gone by the next morning. You may also have some
shoulder pain if gas is used to inflate the uterus. You may
experience light bleeding for several days following operative
hysteroscopy.
You should alert your doctor if you develop any of the
following symptoms:
• Abnormal discharge
• Heavy vaginal bleeding
• Fever (over 101˚ F)
• Inability to urinate
• Severe lower abdominal pain
• Vomiting
• Shortness of breath
What are the risks of hysteroscopy?
Hysteroscopy is a relatively safe procedure with few complications.
Complications only occur in less than one percent of patients.
When complications do occur, they are rarely severe or
life-threatening.
Questions and Answers About Hysteroscopy
7
Summary
Diagnosing and correcting disorders of the uterus once required
major surgery and many days in the hospital. Hysteroscopy now
allows physicians to diagnose and correct many of these disorders without requiring a hospital stay. Recovery time is generally
short, taking only a few hours after diagnostic hysteroscopy and
two to three days after operative hysteroscopy, with only minimal
discomfort. Before you have a hysteroscopy, you and your doctor
should discuss any concerns you may have about these procedures, including their risks.
Notes
8
Questions and Answers About Hysteroscopy